Human immune and gut microbial parameters associated with inter-individual variations in COVID-19 mRNA vaccine-induced immunity

COVID-19 mRNA vaccines induce protective adaptive immunity against SARS-CoV-2 in most individuals, but there is wide variation in levels of vaccine-induced antibody and T-cell responses. However, the mechanisms underlying this inter-individual variation remain unclear. Here, using a systems biology approach based on multi-omics analyses of human blood and stool samples, we identified several factors that are associated with COVID-19 vaccine-induced adaptive immune responses. BNT162b2-induced T cell response is positively associated with late monocyte responses and inversely associated with baseline mRNA expression of activation protein 1 (AP-1) transcription factors. Interestingly, the gut microbial fucose/rhamnose degradation pathway is positively correlated with mRNA expression of AP-1, as well as a gene encoding an enzyme producing prostaglandin E2 (PGE2), which promotes AP-1 expression, and inversely correlated with BNT162b2-induced T-cell responses. These results suggest that baseline AP-1 expression, which is affected by commensal microbial activity, is a negative correlate of BNT162b2-induced T-cell responses.

Phosphoenolpyruvate regulates the Th17 transcriptional program and inhibits autoimmunity

Aerobic glycolysis, a metabolic pathway essential for effector T cell survival and proliferation, regulates differentiation of autoimmune T helper (Th) 17 cells, but the mechanism underlying this regulation is largely unknown. Here, we identify a glycolytic intermediate metabolite, phosphoenolpyruvate (PEP), as a negative regulator of Th17 differentiation. PEP supplementation or inhibition of downstream glycolytic enzymes in differentiating Th17 cells increases intracellular PEP levels and inhibits interleukin (IL)-17A expression. PEP supplementation inhibits expression of signature molecules for Th17 and Th2 cells but does not significantly affect glycolysis, cell proliferation, or survival of T helper cells. Mechanistically, PEP binds to JunB and inhibits DNA binding of the JunB/basic leucine zipper transcription factor ATF-like (BATF)/interferon regulatory factor 4 (IRF4) complex, thereby modulating the Th17 transcriptional program. Furthermore, daily administration of PEP to mice inhibits generation of Th17 cells and ameliorates Th17-dependent autoimmune encephalomyelitis. These data demonstrate that PEP links aerobic glycolysis to the Th17 transcriptional program, suggesting the therapeutic potential of PEP for autoimmune diseases.

Estimation of brain natriuretic peptide values from N-terminal pro brain natriuretic peptide levels and other factors

Funding Acknowledgements

Type of funding sources: None.

Backgrounds

Both brain natriuretic peptide (BNP) and N-terminal proBNP (NT-pro BNP) are established biomarkers that are necessary in the diagnosis and management of heart failure (HF). Recently with the introduction of angiotensin receptor-neprilysin inhibitor in the treatment of HF, the course of HF is now assessed using NT-ProBNP levels1). However, it is difficult to infer BNP concentration from NT-proBNP levels for a physician who is familiar with BNP. Generally, simultaneous measurement of BNP and NT-proBNP is not permitted in medical insurance.

Purpose

To estimate BNP concentration from NT-proBNP levels and other factors as an equivalent prognostic strength compared to the actual BNP concentration.

Methods

From August 2021 to October 2021, we measured BNP and NT-proBNP levels of patients who were known or suspected to have HF (n=200). We created a formula for estimating BNP concentration from the data of NT-proBNP, age, body mass index (BMI), white cell counts, hemoglobin (Hb), estimated glemerular filtration rate) (eGFR) and C-reactive protein (CRP) using multivariate analysis.

Results

Patients’ background were as follows: age 66.4±23.6 years, male /female : 112/88 , BMI: 23.1±5.2 kg/m2, Hb level: 12.3±2.2 g/dL, albmine level: 3.7±0.7 g/dL, eGFR level: 63.3±27.0 mL/min/1.73m², CRP level; 1.80±4.67 mg/dL, BNP level: 103.3±207.9 pg/mL, NT-proBNP level: 1,505.1±3,479.6 pg/mL (mean ± SD). There was a strong correlation between BNP concentration and NT-proBNP level when using actual measured values (r= 0.84) and when using log-transformed values (r=0.92) in these patients.Using multiple regression analysis, we created an equation that estimated

LogBNP=-0.864+0.734×LogNT-proBNP+0.005×age-0.003×eGFR-0.009×BMI+0.016×CRP (R²=0.89).

Conclusion

This equation will be useful, especially for a physician who is not familiar with NT-proBNP. Testing BNP concentrations were reliably estimated from an equation featuring NT-proBNP, eGFR, age, BMI and CRP2),3),4).

P1547 Left ventricular papillary muscle strain as an indicator of hypertrophic cardiomyopathy

Results

Among the 42 patients, 22 (52%) and 17 (40%) had hypertension and HCM, respectively. We measured the strength of linear associations among paired variables (LV-PMS, age, EF, e’, s’, E/e’, E/A, LAV-I and GLS) using Pearson product-moment correlation coefficients.

Age (r = 0.64), e’ (r = -0.76), s’ (r = -0.61), LAV-I (r = 0.61) and GLS (r = 0.57; all p < 0.001), as well as E/e’ (r = 0.44, p < 0.05) significantly correlated in patients without HCM, whereas only GLS correlated in patients with HCM (r = 0.723, p < 0.001).

One-way analyses of variance showed that LV-PMS values significantly differed only among patients without HCM when categorized according to age < 50, ≥ 50 < 75 and > 75 years (p < 0.001), whereas these values significantly differed in all patients (p < 0.05) when categorized according to GLS < -20%, ≥ -20 to < -15% and > -15%.

Conclusions

We found that LV-PMS correlated with five factors including age in patients without HCM, but only with GLS in those with HCM. Despite the small study cohort, we considered that LV-PMS and GLS would be useful for evaluating left ventricular function in patients with HCM.

Interlaboratory Evaluation of Two Enzyme-Linked Immunosorbent Assay Kits for the Determination of Crustacean Protein in Processed Foods

The labeling of foods containing material derived from crustaceans such as shrimp and crab is to become mandatory in Japan because of increases in the number of allergy patients. To ensure proper labeling, 2 novel sandwich enzyme-linked immunosorbent assay (ELISA) kits for the determination of crustacean protein in processed foods, the N kit (Nissui Pharmaceutical Co., Ltd, Ibaraki, Japan) and the M kit (Maruha Nichiro Holdings, Inc., Ibaraki, Japan), have been developed. Five types of model processed foods containing 10 and/or 11.9 g/g crustacean soluble protein were prepared for interlaboratory evaluation of the performance of these kits. The N kit displayed a relatively high level of reproducibility relative standard deviation (interlaboratory precision; 4.08.4 RSDR) and sufficient recovery (6586) for all the model processed foods. The M kit displayed sufficient reproducibility (17.620.5 RSDR) and a reasonably high level of recovery (82103). The repeatability relative standard deviation (RSDr) values regarding the detection of crustacean proteins in the 5 model foods were mostly <5.1 RSDr for the N kit and 9.9 RSDr for the M kit. In conclusion, the results of this interlaboratory evaluation suggest that both these ELISA kits would be very useful for detecting crustacean protein in processed foods.

Determination of Walnut Protein in Processed Foods by Enzyme-Linked Immunosorbent Assay: Interlaboratory Study

Because food allergens from tree nuts, including walnuts, are a frequent cause of adverse food reactions for allergic patients, the labeling of foods containing ingredients derived from tree nuts is required in numerous countries. According to Japanese regulations, the labeling of food products containing walnuts is recommended. To ensure proper labeling, a novel sandwich ELISA kit for the determination of walnut protein in processed foods (Walnut Protein [2S-Albumin] Kit; Morinaga Institute of Biological Science, Inc.; walnut kit) has been developed. We prepared seven types of incurred samples (model processed foods: biscuits, bread, sponge cake, orange juice, jelly, chicken meatballs, and rice gruel) containing 10 g walnut soluble protein/g of food for use in interlaboratory evaluations of the walnut kit. The walnut kit displayed sufficient reproducibility relative standard deviations (interlaboratory precision: 5.89.9 RSDR) and a high level of recovery (81119) for all the incurred samples. All the repeatability relative standard deviation (RSDr) values for the incurred samples that were examined were less than 6.0. The results of this interlaboratory evaluation suggested that the walnut kit could be used as a precise and reliable tool for determination of walnut protein in processed foods.

Enzyme-Linked Immunosorbent Assay Kit for the Determination of Soybean Protein in Processed Foods: Interlaboratory Evaluation

The labeling of foods containing ingredients derived from soybean is recommended in Japan because of an increasing number of patients who are allergic to soybeans. To ensure proper labeling, a novel sandwich ELISA kit for the determination of soybean protein in processed foods (FASTKIT Ver. II, Soybean, Nippon Meat Packers, Inc.; soy kit) has been developed. Five types of incurred samples (model processed foods: rice gruel, sausage, sweet adzuki bean soup, sweet potato cake, and tomato sauce) containing 10 g soybean soluble protein/g food were prepared for use in interlaboratory evaluations of the soy kit. The soy kit displayed a sufficient RSDR value (interlaboratory precision: 9.313.4 RSDR) and a high level of recovery (97114) for all the incurred samples. The RSDr value for the incurred samples was mostly <4.8. The results of this interlaboratory evaluation suggest that the soy kit can be used as a precise and reliable tool for the determination of soybean proteins in processed foods.

Mucin O-glycans facilitate symbiosynthesis to maintain gut immune homeostasis

Background

The dysbiosis of gut microbiota has been implicated in the pathogenesis of inflammatory bowel diseases; however, the underlying mechanisms have not yet been elucidated. Heavily glycosylated mucin establishes a first-line barrier against pathogens and serves as a niche for microbial growth.

Methods

To elucidate relationships among dysbiosis, abnormal mucin utilisation, and microbial metabolic dysfunction, we analysed short-chain fatty acids (SCFAs) and mucin components in stool samples of 40 healthy subjects, 49 ulcerative colitis (UC) patients, and 44 Crohn's disease (CD) patients from Japan.

Findings

Levels of n-butyrate were significantly lower in stools of both CD and UC patients than in stools of healthy subjects. Correlation analysis identified seven bacterial species positively correlated with n-butyrate levels; the major n-butyrate producer, Faecalibacterium prausnitzii, was particularly underrepresented in CD patients, but not in UC patients. In UC patients, there were inverse correlations between mucin O-glycan levels and the production of SCFAs, such as n-butyrate, suggesting that mucin O-glycans serve as an endogenous fermentation substrate for n-butyrate production. Indeed, mucin-fed rodents exhibited enhanced n-butyrate production, leading to the expansion of RORgt⁺Treg cells and IgA-producing cells in colonic lamina propria. Microbial utilisation of mucin-associated O-glycans was significantly reduced in n-butyrate-deficient UC patients.

Interpretation

Mucin O-glycans facilitate symbiosynthesis of n-butyrate by gut microbiota. Abnormal mucin utilisation may lead to reduced n-butyrate production in UC patients.

Fund

Japan Society for the Promotion of Science, Health Labour Sciences Research Grant, AMED-Crest, AMED, Yakult Foundation, Keio Gijuku Academic Development Funds, The Aashi Grass Foundation, and The Canon Foundation.

Regulation of inflammatory response of macrophages and induction of regulatory T cells by using retinoic acid-loaded nanostructured lipid carrier

Immunomodulatory function of all-trans retinoic acid (ATRA) has been gathering much attention for the therapy of autoimmune diseases. ATRA is a chemically unstable molecule which requires proper formulation for targeted delivery. Here we examined nanostructured lipid carrier (NLC) for the formulation of ATRA. NLC is a representative nanoparticle formulation especially suited for oral delivery. We established the preparation procedures of ATRA-containing NLC (NLC-RA) which minimizes the degradation of ATRA during the preparation process. NLC-RA thus obtained was taken up by macrophages and induced anti-inflammatory response via suppressing NF-κB signaling as well as via enhancing the production of anti-inflammatory cytokines. Moreover, NLC-RA enhanced differentiation of naïve T cells to regulatory T cells in the co-culture system with dendritic cells. These results suggest that NLC-RA is a promising alternative therapy for the autoimmune diseases especially intestinal bowel disease.

Therapeutic effect of vitamin D3-containing nanostructured lipid carriers on inflammatory bowel disease

The active form of vitamin D₃, 1,25(OH)₂D₃ has been found to exert multiple effects on the suppression of progression of inflammatory bowel disease (IBD). Vitamin D₃ has been gathering attention as a therapy for IBD. However, the clinical trials conducted to date revealed that a relatively high dosage of vitamin D₃ was required to see a significant therapeutic effect. Thus, effective formulation and delivery of vitamin D₃ to colonic inflammatory lesions will be required. Herein we describe the preparation of a nanostructured lipid carrier (NLC) for the encapsulation of 1,25(OH)₂D₃ for colonic delivery via oral administration. The optimized fabrication procedure enabled the incorporation of 1,25(OH)₂D₃ in the NLC by minimizing the destruction of chemically unstable 1,25(OH)₂D₃. The obtained NLCs orally delivered 1,25(OH)₂D₃ to the colon in mice and maintained a high concentration of 1,25(OH)₂D₃ in the colonic tissue for at least 12 h. The NLC showed multiple effects on the suppression of symptoms of colitis induced by dextran sodium sulfate, namely maintaining crypt structure, reducing the tissue concentration of inflammatory cytokines, suppressing the infiltration of polymorphonuclear leukocytes, and augmenting anti-inflammatory CX₃CR1^high macrophages. Our NLCs containing 1,25(OH)₂D₃ may be an alternative treatment for IBD therapy.

Intestinal Epithelial Cell-specific Deletion of α-Mannosidase II Ameliorates Experimental Colitis

Inflammatory bowel disease (IBD) is a refractory disease of the gastrointestinal tract that is believed to develop in genetically susceptible individuals. Glycosylation, a type of post-translational modification, is involved in the development of a wide range of diseases, including IBD, by modulating the function of various glycoproteins. To identify novel genes contributing to the development of IBD, we analyzed single nucleotide polymorphisms (SNPs) of glycosylation-related genes in IBD patients and identified MAN2A1, encoding alpha-mannosidase II (α-MII), as a candidate gene. α-MII plays a crucial, but not exclusive, role in the maturation of N-glycans. We also observed that intestinal epithelial cells (IECs), which establish the first-line barrier and regulate gut immunity, selectively expressed α-MII with minimal expression of its isozyme, alpha-mannosidase IIx (α-MIIx). This led us to hypothesize that IEC-intrinsic α-MII is implicated in the pathogenesis of IBD. To test this hypothesis, we generated IEC-specific α-MII-deficient (α-MII^ΔIEC) mice. Although α-MII deficiency has been shown to have a minimal effect on N-glycan maturation in most cell types due to the compensation by α-MIIx, ablation of α-MII impaired the maturation of N-glycans in IECs. α-MII^ΔIEC mice were less susceptible to dextran sulfate sodium-induced colitis compared with control littermates. In accordance with this, neutrophil infiltration in the colonic mucosa was attenuated in α-MII^ΔIEC mice. Furthermore, gene expression levels of neutrophil-attracting chemokines were downregulated in the colonic tissue. These results suggest that IEC-intrinsic α-MII promotes intestinal inflammation by facilitating chemokine expression. We propose SNPs in MAN2A1 as a novel genetic factor for IBD.Key words: inflammatory bowel disease, alpha-mannosidase II, intestinal epithelial cell, N-glycosylation.

Violence exposure and resulting psychological effects suffered by psychiatric visiting nurses in Japan

WHAT IS KNOWN ON THE SUBJECT?: There is a developing body of research on violence in healthcare workplaces. Although psychiatric visiting nurses (PVNs) are an important group of professionals who provide medical services for people with mental disorders live in the community, little is known about the experiences and characteristics of violence exposure among PVNs, or the characteristics and work situations of PVNs related to violence exposure. WHAT THIS STUDY ADDS TO EXISTING KNOWLEDGE?: Approximately 40% of participants were exposed to violence during the previous 12 months; approximately 50% had been exposed during their PVN careers in PVN settings. The most frequent violence was verbal abuse. Longer career length as a PVN and greater number of visits per month were both positively associated with verbal abuse during the previous 12 months. Twenty-eight of the 34 participants (83%) who completed the IES-R-J survey had some residual psychological distress, and two (6%) had a potentially high risk of posttraumatic stress disorder. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: In devising policies and strategies against violence, PVN organizations and administrators should consider the characteristics of the violence, especially verbal abuse, as well as the characteristics and work situations of PVNs that are related to verbal abuse. Furthermore, they might provide relevant information on violence in PVN settings within their violence-prevention manuals or education. It would be important to provide support and to construct a safe workplace environment for PVNs who are experiencing residual psychological distress.

ABSTRACT

Introduction Psychiatric visiting nurses (PVNs) play a crucial role by providing medical services for community-living individuals with mental disorders in Japan. However, little is known about violence towards PVNs. Aim This cross-sectional study investigated violence during visits and the resulting psychological effects for PVNs. Methods PVNs were assessed using a violence exposure questionnaire and the Impact of Event Scale-Revised (IES-R-J); a measure of posttraumatic distress. Result Thirty-eight (41%) of 94 participants had experienced violence during the previous 12 months and 49 (53%) over their entire career. The most frequent violence was verbal abuse. Career length as a PVN and number of visits per month were significantly positively associated with verbal abuse during the previous 12 months. The IES-R-J scores indicated 28 of the 34 participants who completed the questionnaire exhibited psychological distress for the most traumatic violence during their career and two had a potentially high risk of posttraumatic stress disorder. Discussion and Implications Policies and strategies aimed at reducing violence in PVN settings should be developed according to characteristics of the violence, as well as the characteristics and work situation of PVNs. Furthermore, the provision of support and a safe workplace environment would be important for PVNs with residual psychological distress.

Auricular Chondritis Caused by Metal Ear Tagging in C57BL/6 Mice

Although it has been shown that auricular chondritis in rats is caused by the use of metal identification ear tags, the pathogenesis remains unclear. Based on the hypothesis that the auricular chondritis is caused by metal ions released from metal identification ear tags, we investigated the pathogenesis in male C57BL/6 mice tagged with metal identification ear tags. Twenty-six weeks after the attachment of the ear tags, visible increases in the thickness of the auricle were observed, and the concentrations of copper and iron in the tagged ears were significantly increased ( P <.05) in the tagged ears compared with the untagged ears. There was up-regulation of metallothionein (MT)-I and MT-II mRNA in the tagged ears, and this was confirmed by immunohistologic staining of the destroyed cartilage. Histopathologically, there were observed severe chondritis with extensive granulomatous inflammation, newly formed cartilage nodules, and osseous metaplasia accompanied by cellular infiltrates, such as CD4 T lymphocyte, macrophages, neutrophils, and mast cells, and expression of Th1 cytokines, such as interferon-gamma, tumor necrosis factor-alpha, and interleukin-2 in the tagged ear. Based on these results, we concluded that the release of copper and iron ions from the metal ear tags played a major role in the onset of auricular chondritis. Subsequent cellular interactions, such as CD4 T cells, macrophages, fibroblasts, and mast cells, mediated by cytokines, such as tumor necrosis factor-alpha and interferon-gamma, caused an autoimmune response that may have led to the progression of auricular chondritis as an autoimmune disease.

Effects of emulsifying components in the continuous phase of cream on the stability of fat globules and the physical properties of whipped cream

The emulsifying components in cream are very important in controlling the physical characteristics of whipped cream. The effects of those components on the stability of fat globules and the physical characteristics of whipped cream were investigated. A low-molecular-weight emulsifier, and protein ingredients such as sodium caseinate and a casein partial hydrolysate (casein peptides), were used as emulsifying components in this investigation. The viscosity of deaerated whipped cream (called the serum viscosity) was measured to evaluate the degree of fat-globule aggregation. Furthermore, the shape-retention ability, which is the degree of reduction in the firmness of whipped cream between immediately after whipping and after 1d of refrigeration, was explored. The addition of the low-molecular-weight emulsifier in the continuous phase of dairy cream, which does not contain added low-molecular-weight emulsifiers, increased the stability of the fat globules and reduced the shape-retention ability of the whipped cream. The addition of protein ingredients (sodium caseinate and casein peptides) to the continuous phase of dairy cream had little effect. However, the addition of casein peptide in the continuous phase of dairy cream together with the low-molecular-weight emulsifier reduced the effect of the low-molecular-weight emulsifier on the stabilization of fat globules and the shape-retention ability of the whipped cream. The addition of casein peptide did not recover the serum viscosity; thus, other mechanisms might underlie this phenomenon.

Variational necessary and sufficient stability conditions for inviscid shear flow

A necessary and sufficient condition for linear stability of inviscid parallel shear flow is formulated by developing a novel variational principle, where the velocity profile is assumed to be monotonic and analytic. It is shown that unstable eigenvalues of Rayleigh's equation (which is a non-self-adjoint eigenvalue problem) can be associated with positive eigenvalues of a certain self-adjoint operator. The stability is therefore determined by maximizing a quadratic form, which is theoretically and numerically more tractable than directly solving Rayleigh's equation. This variational stability criterion is based on the understanding of Kreĭn signature for continuous spectra and is applicable to other stability problems of infinite-dimensional Hamiltonian systems.

Chalcone Tetramers, Lophirachalcone and Alatachalcone, fromLophira alataas Possible Anti-tumor Promoters

Two chalcone tetramers were isolated as inhibitors of Epstein-Barr virus (EBV)-activation induced by a tumor promoter, teleocidin B-4, from a medicinal plant in tropical west Africa, Lophira alata (Ochnaceae). One of them was identified as lophirachalcone. The other, named alatachalcone, was new, and the structure was determined by spectral properties. Both compounds also showed potent inhibitory activities against teleocidin B-4-induced inflammation on mouse ear. In an initiation-promotion experiment on mouse skin, alatachalcone (16 nmol) significantly inhibited tumor promotion caused by 12-O-tetradecanoylphorbol-13-acetate (TPA, 1.6 nmol).

Cervicofacial subcutaneous emphysema associated with dental laser treatment

Cervicofacial subcutaneous emphysema is a rare complication of dental procedures. Although most cases of emphysema occur incidentally with the use of a high-speed air turbine handpiece, there have been some reports over the past decade of cases caused by dental laser treatment. Emphysema as a complication caused by the air cooling spray of a dental laser is not well known, even though dental lasers utilize compressed air just as air turbines and syringes do. In this study, we comprehensively reviewed cases of emphysema attributed to dental laser treatment that appeared in the literature between January 2001 and September 2012, and we included three such cases referred to us. Among 13 cases identified in total, nine had cervicofacial subcutaneous and mediastinal emphysema. Compared with past reviews, the incidence of mediastinal emphysema caused by dental laser treatment was higher than emphysema caused by dental procedure without dental laser use. Eight patients underwent CO2 laser treatment and two underwent Er:YAG laser treatment. Nine patients had emphysema following laser irradiation for soft tissue incision. Dentists and oral surgeons should be cognizant of the potential risk for iatrogenic emphysema caused by the air cooling spray during dental laser treatment and ensure proper usage of lasers.

Statins inhibit tumor progression via an enhancer of zeste homolog 2-mediated epigenetic alteration in colorectal cancer

While statin intake has been proven to reduce the risk of colorectal cancer (CRC), the mechanism of antitumor effects and clinical significance in survival benefits remain unclear. Statin-induced antiproliferative effects and its underlying mechanism were examined using six CRC cell lines. Statins except pravastatin showed antiproliferative effects (simvastatin ≥ fluvastatin > atorvastatin) even though both of simvastatin and pravastatin could activate mevalonate pathways, suggesting the statin-mediated antiproliferative effects depended on non-mevalonate pathway. Indeed, statin induced p27(KIP1) expression by downregulation of histone methyltransferase enhancer of zeste homolog 2 (EZH2), which acts as an epigenetic gene silencer. Additionally, the use of simvastatin plus classII histone deacetylase (HDAC) inhibitor (MC1568) induced further overexpression of p27(KIP1) by inhibiting HDAC5 induction originated from downregulated EZH2 in CRC cells and synergistically led to considerable antiproliferative effects. In the clinical setting, Statin intake (except pravastatin) displayed the downregulated EZH2 expression and inversely upregulated p27(KIP1) expression in the resected CRC by immunohistochemical staining and resulted in the significantly better prognoses both in overall survival (p = 0.02) and disease free survival (p < 0.01) compared to patients without statin intake. Statins may inhibit tumor progression via an EZH2-mediated epigenetic alteration, which results in survival benefits after resected CRC. Furthermore, statin plus classII HDAC inhibitor could be a novel anticancer therapy by their synergistic effects in CRC.

Distal pancreatectomy using a no-touch isolation technique

BACKGROUND AND AIMS

Distal pancreatectomy is the only effective treatment for cancers of the pancreatic body and tail. The recurrence rate after DP has remained high. In an effort to over-come this problem, we developed a no-touch surgical technique for DP. This is a pilot study to see if distal pancreatectomy can be technically done using a no-touch surgical technique with-out deteriorating the post-operative prognosis.

PATIENTS AND METHODS

From November 2000 through May 2011, 16 pancreatic ductal adeno-carcinoma patients have been operated on using a no-touch technique by a single operator. We described the surgical technique, and we reported our preliminary experience. During the procedure, the pancreatic body and tail is neither grasped nor squeezed by the surgeon. And all drainage vessels from the pancreatic body and tail are ligated and divided during the early phase of the operation. Furthermore, for improved dissection of the retroperitoneal tissue (rightward and posterior margins), we use a hanging and clamping maneuver and dissection behind Gerota's fascia.

RESULTS

In the current series, the posterior and rightward resection margins were free in all patients, although seven were positive for anterior serosal invasion. The post-operative prognosis was not deteriorated with this technique.

CONCLUSION

No-touch distal pancreatectomy technique may have some theoretical advantages, which merit future investigation in randomized controlled trials.

High-dose zoledronic acid narrows the periodontal space in rats

The aim of this experiment was to evaluate the histological effects of zoledronic acid on the periodontal space in rats. 40 male Wistar rats were divided into three zoledronic acid groups and a control group. Zoledronic acid was injected subcutaneously at doses of 10, 50, or 500 μg/kg once a week for 3 weeks. The rats were killed 1 or 9 weeks after the last injection. Histological examination of the periodontal space around the incisor tooth revealed that zoledronic acid did not inhibit tooth development. In the rats killed 1 week after treatment discontinuation, the periodontal space gradually narrowed in response to increasing zoledronic acid doses, and the changes were statistically significant according to ANOVA but not according to ANOVA with post hoc tests. The changes persisted in the high-dose zoledronic acid group despite zoledronic acid discontinuation, with significant differences identified by ANOVA and ANOVA with post hoc tests. Therefore, although zoledronic acid had an insignificant effect on tooth development, it had a significant effect on the periodontal space when high doses were administered. The results of this experiment may provide useful information for future investigations on the role of zoledronic acid in the osteonecrosis of the jaw.

Novel Microstructures in Microwave Sintered Silicon Nitride

Preliminary results on microwave sintering of seeded silicon nitride show that a well defined bi-modal grain size distribution is attainable in Si3N4-Y2O3-Al2O 3-MgO sintered bodies by microwave sintering at 28 GHz of materials seeded with ß-Si3N4 particles (2 vol. %). A positive effect on the mechanical performance is anticipated for these microstructurally controlled silicon nitride ceramics

Grain Growth Behavior During Microwave Annealing of Silicon Nitride

A comparative study of grain growth behavior in silicon nitride under conventional and microwave annealing is presented. Microwave annealed specimens showed a faster growth rate as indicated by the quantitative microstructural analysis. The phenomenon was used in combination with seeding techniques to develop a silicon nitride exhibiting a bi-modal microstructure. Microwave annealing was carried out using a microwave radiation frequency of 28 GHz.

A loss-of-function p.G191R variant in the anionic trypsinogen (PRSS2) gene in Japanese patients with pancreatic disorders

OBJECTIVE

There is a concept that pancreatitis results from an imbalance of proteases and their inhibitors within the pancreatic parenchyma. It has been recently shown that a loss-of-function variant, c.571G>A (p.G191R), in the anionic trypsinogen (PRSS2) gene protects against chronic pancreatitis in European populations. Here we examined the association of the p.G191R variant with pancreatic disorders in Japan.

METHODS

Genomic DNA was prepared from 378 healthy controls and 604 patients with pancreatic disorders (241 patients with chronic pancreatitis, 174 with acute pancreatitis, and 189 with pancreatic neoplasm). Mutational analysis of the PRSS2 gene was performed by polymerase chain reaction-restriction fragment length polymorphism and direct sequencing.

RESULTS

The heterozygous p.G191R variant was found in three of 241 (1.2%) patients with chronic pancreatitis, in seven of 174 (4.0%) patients with acute pancreatitis, and in 12 of 189 (6.3%) patients with pancreatic neoplasm. The p.G191R variant was found in 25 (two were homozygous and 23 were heterozygous) of 378 (6.6%) healthy controls. The p.G191R frequency in patients with chronic pancreatitis was lower than that in healthy controls (p = 0.001; odds ratio (OR) 0.178; 95% confidence interval (CI) = 0.057 to 0.561). The p.G191R frequency was lower in patients with alcoholic (0.9%; p = 0.015; OR, 0.132; 95% CI, 0.022 to 0.779) and idiopathic (1.0%; p = 0.025; OR, 0.144; 95% CI, 0.025 to 0.851) chronic pancreatitis than that in healthy controls. There were no statistical differences in the p.G191R frequency between healthy controls and patients with acute pancreatitis or with pancreatic neoplasm. Patients with alcoholic acute pancreatitis (n = 59) had no variant carrier, and the p.G191R frequency was lower than that in healthy controls (p = 0.035).

CONCLUSION

The p.G191R variant protected against alcoholic and idiopathic chronic pancreatitis as well as alcoholic acute pancreatitis in Japan.

Clinical usefulness of mtTFA expression as a predictive marker in colorectal cancer patients treated with FOLFOX

4059

Background: We previously reported that mitochondrial transcription factor A (mtTFA; also designated Tfam) preferentially recognizes cisplatin-damaged DNA via physical interaction with p53 and is upregulated by the treatment with cisplatin and 5-FU (Yoshida et al, Cancer Res. 2003). The aim of this study was to evaluate whether expression of mtTFA predicts clinical outcome in patients with metastatic colorectal cancer treated with modified FOLFOX6 (mFOLFOX6). Methods: From January 2006 to April 2008, 59 patients who had metastatic lesions from colorectal cancer treated with mFOLFOX6 at the Osaka Rosai Hospital were included in this study. They consisted of 25 women (42.4%) and 34 men (57.6%), with a median age of 62 years (29–84). Patients were treated with oxaliplatin 85mg/m2 plus leucovorin 200mg/m2 as a 2-h infusion at day 1, followed by 5-FU bolus 400mg/m2 and 46-h continuous infusion of 2400 mg/m2. Treatment was repeated in 2-week intervals for at least 4 cycles. The expressions of mtTFA and p53 of resected primary tumors were examined by immunohistochemistry. Results: Among 59 patients, one complete response and 32 partial responses were observed (response rate, 55.9%) . The positive rates was 44.1% (26/59; CR 1, PR 7, SD/PD 18) for mtTFA and 59.3% (35/59; CR 1, PR 19, SD/PD 15) for p53, respectively. Strong expression of mtTFA was detected in 8 of 33 CR/PR (24.2%) and in 18 of 26 SD/PD (69.2%), indicating that the expression of mtTFA correlated significantly with response to chemotherapy (P<0.01). On the other hand, there was no significant correlation between response to chemotherapy and p53 expression (P=0.82). mtTFA expression was significantly associated with overall survival (P=0.036) and progression free survival (P=0.037). Multivariate analysis revealed that mtTFA expression significantly impacted on OS (Hazard ratio 2.10, P=0.036). Conclusions: Immunohistochemical study of mtTFA may be useful in prediction of the clinical outcome of metastatic colorectal cancer patients treated with FOLFOX.

No significant financial relationships to disclose.

Fibrinogen induces cytokine and collagen production in pancreatic stellate cells

OBJECTIVE

Fibroblasts in the area of fibrosis in chronic pancreatitis and of the desmoplastic reaction associated with pancreatic cancer are now recognised as activated pancreatic stellate cells (PSCs). Recent studies have shown strong expression of fibrinogen, the central protein in the haemostasis pathway, in the stromal tissues of pancreatic cancer and chronic pancreatitis, suggesting that PSCs are embedded in and exposed to abundant fibrinogen in these pathological settings. The effects of fibrinogen on cell functions in PSCs were examined here.

METHODS

PSCs were isolated from human pancreas tissues of patients undergoing operations for pancreatic cancer, and from rat pancreatic tissues. The effects of fibrinogen on key cell functions and activation of signalling pathways in PSCs were examined.

RESULTS

Fibrinogen induced the production of interleukin 6 (IL6), interleukin 8 (IL8), monocyte chemoattractant protein-1, vascular endothelial growth factor, angiopoietin-1 and type I collagen, but not proliferation or intercellular adhesion molecule-1 expression. Fibrinogen increased alpha-smooth muscle actin expression and induced the activation of nuclear factor-kappaB (NF-kappaB), Akt and three classes of mitogen-activated protein kinases (extracellular signal-regulated kinase (ERK), c-Jun N-terminal kinase and p38 mitogen-activated protein kinase (MAPK)). Fibrinogen-induced IL6 and IL8 production was inhibited by antibodies against alpha(v)beta(3) and alpha(5)beta(1) integrins, suggesting that these integrins worked as counter receptors for fibrinogen in PSCs. In addition, fibrinogen-induced production of these cytokines was abolished by an inhibitor of NF-kappaB, and partially inhibited by inhibitors of ERK and p38 MAPK.

CONCLUSION

Fibrinogen directly stimulated profibrogenic and proinflammatory functions in PSCs.

Clinical benefit of liver hanging maneuver for right-side major hepatectomy

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Background: Liver hanging maneuver is a new technique in anterior approach of major hepatectomy. However, the impact of the maneuver has never been fully investigated in patients with liver tumors. To evaluate the surgical benefits of liver hanging maneuver, we set up a comparative study in right-side major hepatectomy. Methods: From 2000 to 2006, 326 hepatectomy were performed in our institution. Fifty-eight patients with liver tumor (hepatocellularcarcinoma in 36, metastatic liver tumor in 13, and the others in 9) considered for right-side major hepatectomy were prospectively analyzed. Right-side hepatectomy included 26 right hepatectomy, 24 extended right hepatectomy, and 8 tri-segmentectomy. The patients were devided into a group with conventional approach (n = 21), a group with anterior approach without hanging maneuver (n = 19), and a group with approach with liver hanging maneuver (n = 18). In the three groups, age, body mass index, child-pugh classification, type of liver tumor, staging in hepatocellularcarcinoma, tumor size, resected liver weights, intraoperative blood loss, frequency of transfusion and surgical time were analyzed. Results: In conventional approach, anterior approach without hanging maneuver, and approach with liver hanging maneuver, mean age was 55, 59, and 65 years, and mean tumor size was 65, 75, and 108mm, respectively. Patients with liver hanging maneuver were significantly elder (p<0.05) and have larger tumor size (p<0.01). There were no significant differences in body mass index, child-pugh classification, type of liver tumor, staging in hepatocellularcarcinoma, and resected liver weights. Mean intraoperative blood loss was 1771, 805, and 704g, and mean surgical time was 562, 483, and 435minutes, and the frequency of red blood cell transfusion was 33, 21, and 17%, respectively. Patients with liver hanging maneuver had significantly less intraoperative blood loss (P=0.0001) and surgical time (P=0.002). The frequency of red blood cell transfusion in the liver hanging maneuver group was significantly lower than that of the conventional group (p<0.05). Postoperative morbidity rate were 33.3, 15.8, and 16.7%, respectively. Conclusions: Liver hanging maneuver is less invasive and a quite useful method for right-side major hepatectomy.

No significant financial relationships to disclose.